New York's Cannabis Treatment Admissions Dropped 50% While ER Visits Doubled—And Young People Are Falling Through the Cracks
As NY legalized recreational marijuana, cannabis treatment admissions fell 50% in eight years while ER visits more than doubled. Pediatricians lack training, emergency rooms don't link patients to care, and young people with addiction face a system not built for them.
Marcus bought his first delta-8 vape pen from a fraternity brother who worked at a smoke shop. It was February 2022, his final semester at the University of Pittsburgh, and the 25-year-old from Long Island had never used marijuana before. The edible made his mild anxiety disappear. "Nothing else mattered," he said.
By summer, he was taking 60 to 90 hits a day. He vaped in airport bathrooms before flights and Amtrak restrooms on trains back to New York. When New York moved to restrict delta-8 sales, he found stores that still sold it under the counter.
Marcus tried quitting three times on his own. Each time, he failed. Then came a psychosis episode that sent his mother racing to find a rehab bed in Suffolk County. After treatment, he relapsed 12 more times over several months.
His story reflects a widening gap in New York's addiction treatment system: cannabis-related emergency department visits have more than doubled since 2016, but the number of people receiving treatment for cannabis use has fallen by roughly 50% over the same period.
More young people are showing up in crisis. Fewer are being connected to care.
The Numbers Don't Add Up
New York legalized recreational cannabis in 2021 and has since opened roughly 600 licensed dispensaries. But the treatment infrastructure has not kept pace with the consequences.
Dr. Chinazo Cunningham, commissioner of the state Office of Addiction Services and Supports, said the 50% decline in cannabis treatment admissions has multiple causes. Fewer people are entering treatment through the criminal justice system after changes in enforcement and sentencing. And many don't recognize they have a problem.
"Maybe people don't think that cannabis can cause a problem, or they don't think that they have a problem, they don't think that they need treatment," Cunningham said.
Meanwhile, marijuana-related emergency department visits across New York have more than doubled since 2016. In 2024 alone, nearly 670 emergency department visits involved cannabis-related poisonings in children, according to state Health Commissioner Dr. James McDonald.
The gap is especially acute for young people. Dr. Madeline Renny, an assistant professor at Mount Sinai, said the emergency department represents a critical missed opportunity.
"Kids less than 18 have fewer resources for substance use than adults, and very few youth with substance use disorders are linked to care," Renny said. "We know that."
For opioid overdoses, linkage infrastructure already exists: patients receive medication, counseling referrals, and follow-up contacts. Similar programs for cannabis don't.
A System Not Built for Cannabis
Marcus's experience illustrates a broader pattern: New York's treatment system was not designed for cannabis addiction.
Dr. Molly Boyd-Smith, an emergency medicine physician and toxicologist at Albany Medical Center, said resources are concentrated elsewhere.
"The patients who end up getting the more intensive services are the patients who are addicted to cocaine or heroin or fentanyl," Boyd-Smith said. "Those are the patients that there's money being put into services for."
Renny is currently conducting a study to develop and test an emergency department intervention for youth with high-risk substance use. The goal: connect them to ongoing care before they walk out the door.
"The emergency department visit is really an opportunity for us to reach patients that might not seek primary care, or they may not have a connection to health care," she said.
But that infrastructure doesn't exist yet. Patients arrive during a moment of crisis and leave with no clear path to treatment.
Pediatricians Aren't Trained for This
The problem starts before patients reach the ER.
Dr. Matthew Holm, a pediatrician and addiction medicine specialist who treats patients in the Bronx, said most pediatricians are poorly prepared to address substance use of any kind.
"You have a bunch of pediatricians that have poor education regarding substance use in general, about all drugs, that are not well trained, and so thus they're not well equipped," Holm said.
Cunningham, who is a physician, said she received one hour of training on addiction during four years of medical school. Her agency does not have the authority to mandate what is taught in medical schools, residency programs, or pediatric practice.
Dr. Gregory Bunt, a psychiatrist in Rockland County, said cannabis use disorder is treatable, but it's not simple.
"Once you get addicted to a substance, it's not so easy to just discontinue," Bunt said. Withdrawal symptoms—insomnia, anxiety, agitation—are common and can be managed with medication, but relapse remains a persistent risk.
Marcus learned that the hard way. After leaving rehab, he relapsed 12 times. Each cycle was the same: buy a disposable vape pen, take one hit, throw it away. Days later, he'd come back for another.
"One hit, threw it away in the trash," he said. "Three weeks later, same thing. Two weeks later. One week later."
Where to Get Help—If You Can Find It
What finally worked for Marcus was Marijuana Anonymous, a 12-step program modeled on Alcoholics Anonymous. But he didn't find it in New York, where meetings are concentrated near New York City with only a few scattered across upstate.
He found Marijuana Anonymous after moving to Washington, D.C., where meetings were a 25-minute train ride away. The first time he walked in, he was high. He told the group he was scared and wanted to quit. They clapped and hugged him.
Since then, two Marijuana Anonymous meetings have started on Long Island that didn't exist in 2022—one in Salisbury, one near Levittown. One meets Tuesday evenings. The other meets Saturdays at 9:15 a.m.
"I'm not a morning person," Marcus said.
For young people in suburban or rural areas, access remains a challenge. Cunningham said OASAS funds treatment and prevention providers across the state, including in rural counties, but acknowledged the gaps.
"We have to make sure that we have the data so that can be used to guide our work," she said.
What the State Is Doing
OASAS is planning a statewide survey to understand young people's perceptions of cannabis, their attitudes, and usage patterns. The effort is especially urgent, Cunningham said, because the federal government has been cutting expenditures in national surveys that track substance use among young people.
Dr. June Chin, chief medical officer at the state Office of Cannabis Management, said the agency has met with officials from more than two dozen school districts since last July to discuss what educators are seeing and how to talk to students and families about cannabis.
"Young people today are growing up in a world where cannabis is legal and widely accessible," Chin said. "I think that we should focus on upstream."
The agency is also working with Governor Kathy Hochul on a Center of Excellence for cannabis care and health equity aimed at preparing clinicians for a world where cannabis is part of patient care.
But those initiatives are in development. Right now, young people in crisis are walking into emergency rooms and walking out with nowhere to go.
Three Years Sober—and Still Worried
Marcus will mark three years of sobriety in late July. He lives in the Washington, D.C., area now, works as a political campaign manager, and plays in four dodgeball leagues to stay busy.
"You think I want to go to meetings every single day?" he said. "I love them, don't get me wrong, but it takes a lot of time and effort."
His sobriety hasn't erased his worry. He read that people who heavily use marijuana can develop schizophrenia within eight to 10 years after they stop. He's three years in.
"I'll call you back in five years," he said, "and I'll tell you if I get schizophrenia or not."
New York legalized cannabis with the promise that regulation would make it safer. But for young people struggling with high-potency products and addiction, the treatment system is still catching up to the reality on the ground. Emergency rooms see them in crisis. What happens next is less clear.
Written by
MTNYC Editorial TeamThe MTNYC Editorial Team is a group of healthcare writers, researchers, and addiction specialists dedicated to providing accurate, compassionate, and evidence-based information about addiction treatment and recovery resources in New York State.
